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PrEP likely cost-effective, may reduce lifetime HIV risk in South African women

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BOSTON — Pre-exposure prophylaxis, or PrEP, may reduce lifetime HIV risk and increase population life expectancy and lifetime costs of care in South African women, according to results from a simulation model of HIV screening and disease.

“While short-term trials have reported the efficacy of PrEP, there are several questions that the trials could not answer,” Rochelle Walensky, MD, MPH, associate professor of medicine at Harvard Medical School said during a press conference. “We used two efficacy estimates from the CAPRISA 004 and global iPrEx studies to project the cost-effectiveness of PrEP in heterosexual women in South Africa.”

Using a mathematical simulation model of HIV disease and treatment in resource limited settings, the researchers assessed four scenarios including data from the iPrEx and CAPRISA 004 trials. The model examined two scenarios: Women who would be assigned to no PrEP and women who would be assigned to PrEP.

In HIV-negative women, those included in the no PrEP strategy were tested for HIV every 5 years. Those under the PrEP strategy were tested monthly for HIV. Model outcomes included lifetime risk for HIV, life expectancy, per-person lifetime costs, and incremental cost-effectiveness.

Overall, the model projected that PrEP would decreased the lifetime risk for HIV infection among 23.9 year-old women from 39% to 27% and would increase the population life expectancy from 22.8 years to 23.7 years. Lifetime costs of care increased overall from $2,010 to $6,040. The incremental cost-effectiveness of PrEP vs. no PrEP would lead to $4,600 per year of life saved, according to the researchers.

Walensky said that PrEP is likely to be very cost-effective for South Africa and represents excellent comparative value for money.

“Targeting PrEP to high-risk populations will further improve this favorable finding. PrEP could be cost-saving under a combination of highly optimistic assumptions, including, targeting PrEP to very high-risk populations with an annual incidence greater than 9% per year, increasing the efficacy of PrEP to more than 70%, and decreasing PrEP costs lower than $40 per year,” she said. “These findings have important implications for a policy response. PrEP-based approaches to controlling the HIV epidemic are not only effective, they are cost-effective in South Africa. These findings provide sufficient evidence for the implementation of PrEP in high-incidence populations.” – by Ashley DeNyse

For more information:

• Walensky R. #37LB. Presented at: 18th Conference on Retroviruses and Opportunistic Infections; Feb. 27-March 2, 2011; Boston.

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